Citation Nr: 21062175 Decision Date: 10/06/21 Archive Date: 10/06/21 DOCKET NO. 16-25 708 DATE: October 6, 2021 REMANDED Entitlement to service connection for residuals of PO left leg fracture with pin is remanded. REASONS FOR REMAND The Veteran served on active duty from December 10, 1968 to February 17, 1969. These matters come before the Board of Veterans' Appeals (Board) on appeal from April 2016 rating decision(s) from the Department of Veterans Affairs (VA) Regional Office (RO) in Albuquerque, New Mexico. In June 2019, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. In November 2019, the Board remanded the issues on appeal for further development, and the case has since been returned to the Board. The Board finds that the agency of original jurisdiction (AOJ) has not substantially complied with the remand directives as discussed below. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Although the Board sincerely regrets the additional delay, a remand is again necessary to ensure that due process is followed and that there is a complete record upon which to decide the Veteran's claim so that he is afforded every possible consideration. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. Entitlement to service connection for residuals of PO left leg fracture with pin is remanded. The Veteran contends that his left leg condition was aggravated by the strenuous physical activity incurred during his basic training service after being deemed sound for service. In November 2019, the Board directed the AOJ to obtain an opinion regarding whether the Veteran's left leg injury clearly and unmistakably pre-exited service and whether it was aggravated by the Veteran's military service. The Board specifically directed that the AOJ obtain an opinion that addressed the Veteran's lay contentions and the other lay contentions in the record. In December 2019, a VA examiner provided an opinion. The examiner concluded that there was no evidence of a new injury while on active duty and noted that X-rays revealed mild bilateral arthritis. The examiner did not address the Veteran's lay statements, the other lay statements of record, nor did it address the Veteran's service treatment records. Thus, because this examination is inadequate, a new examination is required. Barr v. Nicholson, 21 Vet. App. 303 (2007) (holding that once VA undertakes an examination, it must provide an adequate one). The matters are REMANDED for the following action: Forward the Veteran's claims file to an appropriate clinician for an addendum opinion as to whether the Veteran's pre-existing left leg injury clearly and unmistakably did not increase in severity (beyond natural progression) during service. If the clinician deems additional examination of the Veteran is necessary to provide the requested opinions, then such examination should be scheduled. The examiner is asked, considering the evidence, accepted medical principles pertaining to the history, manifestations, clinical course, and the character of the disability found, to address the following questions: (a.) Is it at least as likely as not that the Veteran's preexisting left leg injury, noted upon induction into service, underwent increase in severity in service? The examiner is directed to consider that an increase in the disability is a chronic worsening of underlying condition as opposed to temporary flare-up of symptoms. Stated another way, a permanent increase in severity of the preexisting condition, that is, an irreversible worsening of the preexisting condition during service on the basis of the manifestations prior to, during, and subsequent to service. A rationale should be provided for the opinion proffered. In rendering the requested opinion, the examiner is asked to discuss the Veteran's credible reports of in-service aggravation of his left leg. (b.) If the Veteran's preexisting left leg injury, noted upon induction into service, underwent increase in severity in service, is there clear and unmistakable evidence that such worsening of the preexisting left leg injury was due to the natural progression of the disability? In this regard, if the conclusion is that an increase in disability was due to the natural progress of the leg disability, then the examiner is asked to identify the clear and unmistakable evidence there is to support that conclusion. In providing the opinion, the examiner must consider and discuss any lay statements of record, to include the Veteran's statements regarding the onset and persistence of his symptoms. If aggravation is found, please identify to the extent possible the baseline level of disability prior to the aggravation and determine what degree of additional impairment is attributable to aggravation by service. Finally, the clinician is advised that the opinion must be based upon clear and unmistakable affirmative evidence demonstrating the increase in disability was due to natural progression and cannot rely on the insufficiency of the evidence. L. M. BARNARD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M.D. Taylor, Associate Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.